I have called this lecture ‘Looking beyond Professionalism’ because sometimes we need to do exactly that – look beyond the end of our noses. We need to understand the wider picture – to see and appreciate the full impact of our actions.
Clinical professionalism is vital, but it is not enough. We have to be business professionals as well. And, for some of us, at least, that could mean working outside our comfort zone.
Ruth Alston wanted to bridge the gap between OH and business or, if you like, between professionalism and commerce. The dictionary defines ‘professionalism’ as ‘the exceptionally high and consistent good conduct, aims or qualification that characterises a profession or a professional person.’ It defines ‘commerce’ as ‘the exchange or buying and selling of commodities, especially on a large scale.’
Let’s start with professionalism. OH practitioners have worked long and hard to gain their qualifications. They have done at least three years in general nursing, followed by additional training up to degree level. Along the way, they have put the skills they have learned into practice. They have gained experience, and enhanced their competence.
As nurses, we are right to be proud of our personal achievements, and the career path we have chosen. And we must protect the exceptional standards of good conduct upheld by the Nursing and Midwifery Council (NMC). But we cannot afford to rest on our laurels. We must continue to invest time and thought in education about best practice, and, in reflection, on what it is and how it needs to change.
But that alone is not enough.
We need to look beyond our profession; beyond even the rigorous standards we apply to it. Because we need to look at the world our customers live in – the world of commerce. And we urgently need to understand it as well as we understand our own. That means putting our preconceptions to one side, and seeing ourselves as they will see us.
Our customers usually see us as the means of resolving an issue. They may be interested in healthcare, particularly if it relates to their business, but for the most part they are focused on business results, be it engineering, food, IT communication, or even healthcare.
In the world of healthcare, our patients stand at the centre. Our chief concern is their health, their general well-being and, if they have a problem, their treatment and care. That is what we do, and those are the skills and competencies that we bring to the world of work, because we practice OH nursing, which is the link between health and work.
But these are two very different worlds – and intriguing things can happen when those worlds collide.
For example, over the past few months, we have seen a lot of media coverage about sickness absence. There has been a big growth in demand for OH professionals to help with the management of these cases. That demand increases when the illness involves long-term absence from work.
We, as a profession, cannot present our knowledge and our skills as we would do in a patient care environment. We need to present them in a different way, and in terms our customers can understand. That means using their language, not ours.
OH is increasingly in demand and is flourishing. However, there are just 3,500 qualified occupational nurse practitioners in the UK – and just over 1,000 qualified doctors in this specialist area. And many of our healthcare colleagues still seem to think that our job is to go in when the customer has a problem, not as part of a more holistic approach where we can provide care for the staff that will, in the long term, benefit the business as a whole. It is more important than ever for all of us to get inventive about providing care in the workplace and linking up with GPs.
We face a considerable challenge, because whatever we do, we can be seen as ‘piggy in the middle’. We run the risk that employers see us as expensive do-gooders, while GPs see us as a threat. And when we visit customers, we run the risk that management will see us as a means for employees to make ever greater demands on them, while employees see us as a tool of the management. Everyone sees us both as a potential ally, and as a potential adversary, and walking that particular tightrope calls for skill, diplomacy and, wherever possible, experience.
It is very important for OH to form working relationships with key managers. But whether the client is large or small, the services we offer are not dictated by how knowledgeable we are, or how much we care, they are dictated by how efficiently and effectively we can provide what the client needs. Everything we do must be well organised, and flexible – and above all, the OH adviser must be approachable. We need to understand both the employer’s and the employee’s points of view.
Presentation is equally important. The invoices must be as prompt, neat and accurate as the service reports and the management feedback correspondence. Customers usually want to see a service that gives them confidence in what we say and do, and they want reliable and credible advice and recommendations. But above all, they want these things delivered in a way that fits the business world. They want pragmatic solutions, because they want what is best for the business, not just what is best for individuals. The question is: how does that square with our approach, as responsible healthcare professionals?
Ideology versus pragmatism
We all want to provide the best healthcare possible, but we must be careful not to limit our work to just focusing on illness. We need to focus on prevention, and on achieving optimum health; on ensuring that people are fit for work; and on making practical recommendations that enable the manager and the employee to reach decisions about work and capability. We can mediate between employers who are anxious not to look like a ‘soft touch’, and employees who do not always see the real value of what we are doing. But we need to tackle our work with care and imagination.
For instance, does a pre-employment health screening questionnaire cover questions about capability and lifestyle? Is it linked directly to the work people will be doing? Is there a ‘hands-on’ health assessment as part of the new employee induction program? There needs to be – because this is when we can establish a baseline health status, and identify any likely need for health surveillance.
Much work has already been done to find out why people do not come to work. Poor health is frequently used as the reason, though in many cases other factors have been just as important, or more important, in making the decision not to work. But in all these cases, our role is to give information, advice, and recommendations; to help the individual, and their managers, make sensible decisions about work attendance and performance.
Today, OH is in an enviable position – a position where we can have a major influence on community health by working in the business world. Many employers and community members have heard of the ‘Revitalising Health and Safety’ strategy, and the document called ‘Securing Health Together’, and some organisations have set targets for reducing ill health and injuries. They have taken a range of different approaches, including healthy eating programmes, stress management at work, and even corporate membership of fitness clubs. So we are having an influence – but influence brings responsibility, and it is our responsibility to ensure that we provide the best business practice.
We must demonstrate what best business practice is. And we must become a profession that is always consulted before government and other organisations set standards that affect our work. It is vital for us to have our say – and be heard – before standards and methods for managing health are enshrined in regulation and protocol.
As a profession, we have a tendency to focus only on the ‘back office’ – on what we do, and do well. It is time to take off our clinical blinkers and present ourselves, out there in the marketplace, as a business-like, professional service that our customers can recognise and understand.
That does not mean our professional standards will change. They will still be there, and fully operational, in the back office where they belong. And we will also be working in close partnership with other business functions – most notably, safety officers and HR departments. Together we can pool and develop our business knowledge, and in particular, our approach to workplace hazards and risks.
Our role now is to demonstrate the value of the OH nurse practitioners working with others (safety, human resources, key managers) to contribute to the businesses objects and reduce chronic loss of productivity. We will do that by reducing absences caused by ill health, by making the workplace safer, and by preventing health-related employment litigation.
By building and developing our ‘shop window’ – and our relationship with the marketplace – we are opening the way to achieving the political and commercial influence that we need to shape the future of our profession. Organisations like COHPA (Commercial Occupational Health Providers Association) are, effectively, creating a lobby that will make our voice heard, with the active support and co-operation of the business electorate.
So how can we present this ‘shop window’ to a prospective client? My approach is to make sure our customer understands that we are professional OH practitioners – nurse practitioners, working in the commercial arena and offering four main services:
- Assistance to select and recruit the best people, through pre-employment health screening
- Manage health risks for the business, through health assessment and surveillance
- Positively manage attendance, through health reviews and health promotion
- Ensure actions are taken based on good advice through careful record keeping, risk assessment, health audits and reviews, policy development, instruction, training and information for them and for the workforce.
I explain that our management system enables us to deliver these services effectively. It reassures the client that we have the kind of credibility they are looking for, that we have a stable and durable organisation, understand commercial realities and have the leadership structure in place to deliver what we are offering.
Furthermore, we are able and ready to meet the demands of our market, which means we can respond to government requirements and to political and social issues. We can provide advice and support to deal with sicknotes, with claims and litigation, with stress issues, with downsizing and with redundancies.
I then confirm that our professional services are delivered by qualified practitioners in the field of OH, HR and safety, in other words, we know what we are doing, and we have a multidisciplinary approach. Finally, we talk about image – and the way that our image must reflect theirs if we are to work successfully with them and with their organisation.
For OH to achieve its goals, we need to lobby the Government to bring together expertise in the areas of health, safety, HR and business management, and to apply standards to this area. We need to recognise the benefits of a team approach. And we need all commercial providers to work in an efficient and effective way, because in this arena, business standards give us the framework we need to build effective professional standards.
The Investors in People (IIP) Award and Quality Management Systems, such as the ISOQAR 9000/2, is the ideal starting place. There are, of course, other approaches, but it is vitally important is to get our collective act together, and to do it soon.
Once we are seen as credible business services, and can work together as a cohesive industry, we can reflect our findings back to the Government. Then the Government will feel able to consult us as the proven source of expertise – and as the link between health and work in the community – while we, for our part, look beyond professionalism to our developing role in the commercial world.